Book Reviews

In his previous monograph, Concepts and Objects (Acta Philosophica Fennica, Vol. 63, Helsinki 1998), Pavel Materna developed a theory of concepts based on Transparent Intensional Logic (TIL) founded by Pavel Tichý (see his Foundations of Frege’s Logic (Berlin: Walter de Gruyter, 1988) and Pavel Tichý’s Collected Papers in Logic and Philosophy (Prague: Filosofia, Dunedin: University of Otago Press, 2004)). A short chapter of the book was devoted to conceptual systems, a topic highly interesting from various logical and philosophical points of view. However, the chapter was too short to enable a thorough discussion. Materna’s new book, Conceptual Systems, is a sequel aimed at elaborating the topic partly and insufficiently discussed in the previous book. Materna’s considerations in Conceptual Systems are important both for philosophy of science as well as for semantics. Regarding the former, Materna discusses a vast variety of problems connected with comparison of theories and their incommensurability; regarding the latter, he makes two crucial steps: firstly, he proceeds in a Churchian way and identifies meanings with concepts; secondly, he claims that “the meaning of an expression E (of any language) can be identified with that concept which is the best analysis of E” (p. 7). The importance of conceptual systems for semantics can be expressed as follows: “which analysis is the best one is unambiguously determined by a given conceptual system” (ibid.). (What is to be taken as the best analysis within a given conceptual system is discussed on pp. 92–95.)

The Lectures of Doctor Broussais, on the Gastric Phlegmasia called idiopathic continued Fevers by Authors, and on the acute Cutaneous Phlegmasia, + M. Broussais has for several years promised to develop more fully his doctrine, especially as it regards some particular diseases, than he has done in his Examen and the Histoire des Phlegmasies Chroniques ; but, while this exists in expectation, two of his pupils dedicate to him liis Lectures on some of the most interesting points of it, and, in patronizing the work, he might be considered as recognizing the doctrine as his own. But a perusal of these Lectures has led us to be confident that this can only be done in a general manner : there is so much vagueness in many parts of them ; so little connected reasoning in the exposition of general principles; and, on many occasions, such imperfect accounts of what is clearly and comprehensively displayed in the writings of M. Broussais. How, then, are we to regard these Lectures ? and what use are we to make of them ? As the exposition of MM. de Caignou and Quemont of certain parts of the Professor's doctrine, with the imperfections, to say no more, consequent on its being derived from instruction from the chair. We shall, then, place these Lectures by our side, whilst we proceed with our own exposition, and refer to them when they speak in a particular manner on points only treated generally in the Examen and Histoire dts Phlegmasies Chroniques: always, however, taking care to designate what we derive from this source, that it may not be confounded with what we give as Ei'posiiion of the Doctrine of M* Brmissais. 6t tire doctrine of M. Broussais; and, in order (hat no confusion *najr arise, we shall place within parentheses alt that is taken from MM.de Caignou and Quemont.
The nature of the varieties of organic lesion consequent on the various species of inflammatory action, will first eng:ige our attention; and, as we have already given an account of M. Broussais* pathology of inflammation generally, we may proceed immediately to its particular application, and the history of the phenomena resulting from its existence.
M. Broussais considers that a distinction may be made between inflammation as it affects the red capillary, or sanguiferous^ vessels; and that of the white, or lymphatic vessels. The former may be either more or less acute ; to all the varieties of the latter he gives the generic term sub-inflammation; and he calls mixed inflammation the simultaneous irritation of the sanguiferous capillaries, and the exhalant, absorbant, and secretory, vessels. Here M. Broussais has not been tiappy in the choice of his expressions: if the term snb-injlammali^n can convey any precise idea, it must be that of an inferior degree of inflammation, considered absolutely ; not, as he intends to signify, a relatively inferior degree of exalted action, when compared to excitement of a similar nature having its seat in other parts of the system: it would therefore have been better to have chosen some terra merely designative of inflammation of the white vessels, or exhalants.
The various modifications which irritation, resulting from the impression of a stimulant of any kind, will effect on the organs, may be observed in the following states : 1?, in all the tissues, inflammation of the sanguineous vessels, carried to a high degree, determines the transformation of the part into a red mass, more or less compact, and variable in volume, according to the degree of development of which the organ is susceptible ; a less intense degree of irritation, when it does not terminate by delitescence or resolution, transforms the cellular and parenchymatous tissues into a substance analogous to that already designated, but less red and less painful; 3?, in proportion as it extends from the epoch of the invasion of the disease, the induration or red carnification becomes more pale: it terminates by assuming a white aspect, which indicates that the non-sanguiferous vessels have contracted the irritation, whilst that of the red capillaries, which gave the impulse to the disease, has subsided; 4C, when the white vessels are irritated without any apparent previous inflammation, the tissues assume, in the first instance, either the aspect above mentioned, or one of those about to be described ; after this modification of the vitality of the white vessels has lasted for a greater or less length of time, we find united in the tumor, especially when the affected part is of very complex organization, a great number of different matters, such as white, grey, or yellow indurations, in masses more or less considerable in size, and more or less analogous to that which has been called schirrous, cancerous, and tuberculous, matter, with calculous or osseous concretions, in the midst of those masses; and at ofher times they are iuterspersed in a confused manner with white, yellow, greyish globules, more or less hard and friabfo; a period arrives at which 62 Foreign Medical Science and Literature. these extraneous bodies, modified by the vital actions, become deConfJ posed, and irritate the adjacent parts, and these become themselves the seat of inflammatory excitement, which destroys them and proj duces ulcers, the progress of which is often attended with considerable ravages.
Let us now proceed to the development and illustration of the foregoing propositions.
Inflammation of the sanguiferous vessels may be dissipated at the end of a certain period; and this is termed delitescence, or resolution. (Some evacuation or other, termed critical, is then observed, say MM. De Caignou and Quemont: sometimes abundant sweats appear,, the cutaneous exhalents then assuming more activity. Sometimes there are copious evacuations of urine, with a copious deposition of a mucous sediment, forming a cloud, in the middle of that fluid. The former phenomenon is observed in phlegmonous and parenchymatous inflammations of considerable extent. The local consequences are a softening and subsidence of the tumefaction of the part, accompanied by absorption of the fluids evacuated during the inflammation ; and often no sensible traces are left in the cellular tissue. These observations apply especially to delitescence. When it may be said to terminate in resolution, there are sometimes found adhesions of the cellules of the tissue above mentioned ; which is also remarked after this mode of termination in serous membranes. In the mucous membranes, the exudation, in the first instance wanting, becomes serous and abundant; then more thick, and of a mucous appearance: it approaches to the nature of pus. The membrane suffers no alteration in its texture.
In the parenchymatous structure, the product has a cream-like appearance.
The resolution takes place in the same manner as in the mucous membranes.
In the cutaneous texture, it terminates by desquamation. In the fibrous textures, it leaves a coating over the parts, that gradually disappears. It is not known how it terminates in the synovial membranes. In general, when not evacuated externally, the product is absorbed, and then thrown out of the system by some of the excretory organs.) 2Q. It may produce a too.rapid sanguineous engorgement, which overpowers the vitality of the part: this is gangrene by excess of inflammation. (In the lungs, local death is manifested by a real apoplexy affecting the organs, so that their functions are suddenly suspended by the afflux of blood and the compression of the bronchial vessels, produced by this fluid. In this case, general death takes place sooner than gangrene, from the importance of those organs. This phenomenon prevents our finding, on opening the dead body, any trace of putrifaction. Gangrene of the lungs is extremely rare: it sometimes takes place, especially as a consequence of deleterious causes ;* and then only one lung can be affected, the sound one supplying the functions of the other, and prolonging life sufficiently to permit it to putrify. We have observed a few cases of this kind.) * The expression of MM. De Caignou and Quemont;?perhaps inspiration of some gassous fluid is meant.
Exposition of the Doctrine of M. Broussais. 63 3?. It may disappear, because of the organs dying from previous debility of the vessels, or from the influence of a deleterious or sedative cause, which may itself have been local irritation: this is gangrene by debility. (Gangrene from a deleterious cause, malignant pustules, and carbuncles, should be arranged with those which depend on debility, because the poison destroys the vital powers in the midst of the inflammation.) 4?. By producing suppuration ; which supposes that the sanguife. roas capillaries terminate on a cellular or serous tissue capable of ex. pansion. (in this case, the irritation is not confined to the red capillaries; and the proofs of it are, (a) that inflammation may per. sist in them for a long time without producing pus; (b) that pus may be formed by cellular and serous tissues, without having been preceded by inflammatory symptoms. The termination of inflammation that produces pus, supposes two things: (a) that the part is furnished with an expansible cellular and serous tissue; (j3) that the inflammation is communicated to this tissue in the peculiar degree which produces suppuration. The cellular tissue existing in very small proportion in the dura mater, true pus is very rare. The secreted liquid is rather transparent and gelatinous : collections of true pus are, however, found there. The product of inflammation of the arachnoid membrane* resembles that of the pleura and the peritonenm. Irritation of the sanguiferous vessels may exist without the formation of pus. In setons, suppuration is often suddenly suppressed, although the irrita. tion and redness continue to exist. This phenomenon may be observed in all the tissues susceptible of inflammation. We may then conclude, that suppuration is only an incident in inflammation. If we see phlegmasia* become chronic because they are kept up by the pus, there are also others found existing a long time without this cause. There are examples of persons who, for several years, have presented all the symptoms of inflammation of the viscera, in whom, on examining the dead body, not the slightest trace of pus is present, nor even the smallest appearance of suppuration.) 5Q. It may continue in a chronic character: its effects then present a multitude of varieties, according to the texture of the part, its vitality, and the general disposition of the patient. The principal results are: (a) sometimes it is confined to the sanguiferous capillaries, permanent congestion in which presents the red induration, which takes different names according to the organ in which it is seated : in the skin and cellular tissue, callosity ; in the mucous membranes, no particular name; in the lungs, hepatization, &c. But all the tissues do not submit themselves to this form of alteration. If the chronic inflammation * Meningette is the term used by the writers of the Lectures:?we think they mean the arachnoid rather than the jiia-mater. Meningine we translated duratnaler.
Our translation appears to be correct only from the pathological observations applied to those terms. M. Brous?ais has never used them in his writings; and, if he has orally, it is bnt lately that he lias done so. The writers of the Lectures should have explained what they meant. This must he placed amongst the multitude of faults in their publication of the Lectures of the professor at t^e y^l-de-Grace.
(H Foreign Medical Science arid Literature^ is Dot confined to the red vessels, then, {b) in the cellular Irssue, it will produce pus, which, if it be retained ancl decomposed, may itself keep np the inflammation, until the general exhaustion of the vital powers, Is the consequence; (c)in the membranes, the results will be different according to the tissues which exist in them, and the disposiiion of each of tbem to contract irritation: it may then develop phlyctenae, herpes, dartres, indurations, ulcers, pustules, horns, tubercles, &c.: in the mucous membranes, a copious secretion of mucus, more or less resembling the pus of phlegmon; a concrete, cream-like, suppuration; and the ulceration of cryptae: in the serous membranes, an exudation of a multitude of varieties of character; (d} in the parenchymatous secreting organs, suppression, augmentation, or alteration, of the product of their secretion ; (e} in all the organs, without exception, it may derelop the cellular tissue, produce fasciae of various kinds, and alter the lymphatics, so as to present all the degenerescences termed cancer, phthisis, scrofula, and fungus haematodcs.
The alterations of structure arising from inflammation of the white vessels, appear under various forms, according as different species of vessels are particularly affected. (1?. The tuberculous. The glands which present this alteration, first acquire increased size and hardness ; from red they pa$s to drill white, then become soft, and take the consistence and colour of cream.
It is seen in the glands of the bronchiae and mesentery. The same alteration is observed in the absorbent vessels of the cellular and serous tissues.
2?. The lardaceons. It is so termed from the resemblance it has with lard. It# seat is in the cellular tissue, which it renders, as it were, infiltrated with gelatine. It is not possible to say what are the vessels which most contribute to its formation. 3?. The eneephaioid or cerebariform. This is white and softish, and is observed in the cellular tissue; it nearly approaches to the tuberculous. 4?. The melanose, thus termed because of its blackish colour, does not make a distinct species from the preceding. The black colour affects indifferently all the dcgene^ rations. 5?. The cartilaginous, the osseous, and the calcary. The two former are sometimes organized, and are met with in the ossification of arteries and of the cellular tissue. The third is inorganic: it is found in the midst of the depositions of matter established in the different disorganized tissues. It is also observed in some glands. 6?. The degeneration into erectile tissue, thus termed from its analogy to that of the corpora cavernosa.-It appears in the skin, in naevi tnaterni and fungus ha^matodes. The nature of it is not well known, but it appears to appertain to the sanguiferous capillaries. It has been seen in the different viscera. 7?. The polypous, or fungous degeneration. It is a vegetation which arises from' the cellular tissue* This vicious nutrition is sometimes observed with the alterations already spoken of. It contributes, perhaps, to the carcinomatous and cancerous degenerescence, which forms the highest point, and,-as it were, the termination, of the disorganizations. 8?. Encysted degenerescences, and the transformation of one tissue into another, without speaking of ossifications and accidental formation of cartilage. It is thus are formed cysts endowed with hair, species of accidental intr? coua membranes, and (hat certain cysts are developed around coagu?4 of blood, and foreign bodies present in their interior a smooth exhalant surface, analogous to that of the serous membranes.) The many points in which M. Broussais, Dr. Baron, and Mr; Langstaff, concur on this subject, will be immediately discerned.
The difference between them may probably depend more in words than in ideas. In using the term inflammation, M. Broussais only means tri signify a certain alteration in the action of the vessels, which he believes to be greater than the natural action, because it arises from the impression of stimulants, and it passes to what is evidently inflamma. tiori, and returns again to the former state, merely from the impression in a greater or less degree of the same causes, and with only a variation of the same general phenomena. Somewhat seems to depend, too, on the different constitution of different individuals; for we see that, from identical causes, sanguine robust subjects are affected with violent phlegmasia; whilst the less strong, slender, lymphatic, feebly developed, subjects, have them in a less pronounced degree, and of the chronic character from the commencement. It is in the latter that irritation is tacitly communicated to the lymphatic vessels, and insensibly leads to tuberculous and other disorganization. We find also^ 1?, that, whenever those disorganizations have been preceded by general irritation of the sanguiferous system, their progress is more rapid in proportion as that has been more violent. 2?. When they have* not been preceded by such irritation, the cause has nevertheless always been stimulant, as is proved by their etiology; and their progress may be accelerated or retarded, by calming or rendering more powerful the action of those stimulant agents. 3?. They are always seen developed in those tissues endowed with the greatest vitality, in the periods of life when those tissues enjoy the greatest activity, and never in parts which have become affected with paralysis. M. Broussais shows, too, that there is no tissue in which the disorganizative irritation may not be developed in two different manners: 1?, with violent re-action of the sanguiferous system ; 2?, without being preceded by this re-action. It is important to remark, that these affections influence other parts^ according to the common laws of sympathy: as this will explain the transmission of the disease from one part to another, &c. and all the circumstances supposed to indicate the existence of a specific virus.
We have not terminated the exposition of the doctrine of M. Broussais: something should be said respecting ulceration in those degenerescences. Whenever the phenomena which accompany can* cerous decomposition, or the ulceration of schirrous and tuberculous masses, are observed, we find, says M. Broussais, that inflammation of the sanguiferous vessels is developed, and that the progress of the disorganization thence arising is more rapid as that inflammation has been more intense. We always see simultaneous in-* flammation of the sanguiferous and non.sanguiferous vessels, for that constitutes the character of disorganizing and propagative inflammation; and this mixed inflammation is never developed but under the influence of either local or general excitant causes. All those sub. stances, then^ which stimulate locally, or which sympathetically exalt no. 251. K.

6
Foreign Medical Science and Literature* the actions of the nervous and sanguiferous systems accelerate the pro gross of the disease.
We have not yet spoken of the influence of the local diseases above 4es?gnated oa the functions of other parts of the system; but, we shall now give a general summary of the phenomena which thence result. ; Inflammation has a more powerful influence on the exercise of the functions in proportion to the greater degree of its energy, and vice rtrsd. Thus, Exposition 6/ the Doctrine of Ml Broussdis? GT on this point, which we only gave id # genera! manner in the foregoing exposition. After having collected and combatted the arguments of his adversaries, he establishes, u that tbe non-sanguiferous vessels of different orders, whether exhalents, absorbents, or seeretors which are endowed, as Bich&t demonstrated, with a peculiar irritability and species of vitality necessary for tbe exercise of their functions, are susceptible of aberrations in their properties, independently of that ex*> altation of action of the sanguiferous system which we qualify with the term inflammation ; nevertheless that, in the most ordinary cases, this aberration is communicated to them by the inflammatory state, as all those know who have taken the trouble to trace, in a great number of instances, the origin of congestions, schirrosities, &c. This fact leads ns, then, to think that, in the cases where the tumefactions are not preceded by the inflammatory state, the aberration which disorganizes them is not less the effect of an exaltation of their organic action. The causes which preside over their formation in the latter circumstances, show the propriety of this manner of regarding them ; since these causes may be always reduced to either an immediate or a sympathetic excitation, which has augmented the vital action in the degenerated part at the expense of that of others. I may here repeat what I said in speaking of haemorihagies and inflammations; which is* that these alterations, or degenerations which are developed in tbe non-sanguiferous vessels, are ordinarily manifested in the organs en. dowed with the greatest vitality : in those where the vessels in question are animated by numerous sanguiferous capillaries; in those where we find, with those conditions, a great number of nerves, much sensibility, and a close texture', which opposes itself to a free development of the phenomena of inflammation ;?such are the breast, the facial region, the most firmly bound and most sensible parts of the digestive canal, the neck of the uterus, the parenchyme of the lungs, and, lastly, ail parts of the body, (for the same tissues every-where exist,) when a violent cause of any kind has for a long time exalted their vital properties."?-Examen, pp. 298-300.
M. Broussais has on these principles endeavoured to prove that it is possible, if not to obtain the resolution of the tumors formed by those new tissues, at least, to prevent their formation in the greater number of cases. If, indeed, they are ordinarily the result of prolonged irria tation, it is evident that, in combatting this irritation by appropriate means, we may evidently prevent the degenerescepces that arise from it in the greater number of instances. When the disease is seated in external parts, emollient applications, local blood-letting, ami a severely-restricted diet, are the means to be employed in their cure. The body should be made to live at its own expense, in a manner, for a certain length of time. It was by following the latter indication that Girardot had such astonishing success in the treatment of scrofula.
Fames recte ordinal a, scilicet nimia et prava ciboruvn ingestio cautt tt indesinenter prohibita, he regards as the chief means of cure; and, he continues, frustrd sudaverit medicus strumosam pharmacis in&e. quendo diathesim, nisi congarurenter famem foverit. Sometimes, when inflammation of the sanguiferous vessels isa not conjoined, stimulants k 2 68 Foreign Medical Science and Liter a iure. may be employed to change the mode of irritation locally, or develop the action of sympathizing organs, and thus produce revulsion. Some-? times specific stimulants are required, as that of mercury in syphilis, &c. It is said in the Lectures, that M. Broussais does not believe that any of the medicines employed with this view go directly to the organs they seem especially to affect: the latter are acted on solely by their sympathetic connection with the stomach, which produces different effects on different parts, according to their peculiar sympathetic relations to it:?Exactly the opinions of Dr. Chapman, of Philadelphia. ' It now remains for us to show how far the foregoing principles will explain the phenomena of some organic diseases, which, when seated in certain organs, have received peculiar names,?as phthisis, scrofula, &c.; we shall also give a general account of M. Broussais's theory of scurvy; and then we shall attend more particularly to the Lectures, for the purpose of illustrating some of the principles developed on for, mer occasions respecting gastric inflammations.
Whilst waiting for the completion of the sources whence the means for giving a full exposition of the medical doctrine now prevalent in Italy must be derived, we received some fasciculi of a work published at Bologna, for the express purpose of tracing the origin and progress of the most important parts of that doctrine,?-those which relate to febrile diseases, and the mode of agency of certain medicinal substances on the human body. These fasciculi contain analyses of the Treatises of Rasort and Guani ; and, since we have not yet received those works, and that a full account of them, as containing the bases of the modern opinions, must form a proper proemium to a general summary, we shall now give a translation of those analyses ; which we do with full confidence that they are effected with accuracy, from our knowledge of the talents of the author: but, as he has chosen to remain sub umbra, we cannot show our readers on what grounds that assertion is made. At present we adduce no reflections of our own on the sentiments about to be laid before the reader; we only premise that, although we adopt the following articles, we do not identify our opinions, on all occasions, with those which they contain.
fhe History of the Petechial Fever oj Genoa in the Years 1799 &nd 1800; and some 'Hints respecting the Origin of Petechial Diseases, 6fc. By G. RasorIj Doctor in Medicine of the first Class, &c.
Milan, 1813.* At the commencement of the present century, the opinions of Jqhi* J3iio\fN were adopted by the greater number of physicians in Italy; jtnd that scholastic chief, not less celebrated in Germany than in the former nation, acquired from day to day additional reputation and * Storia della Febbre Petecchiale di Genova, negli anni 1799 e J 800, ed alcuni cenni, $u IV Origine della Petecchiale. Terza edizione, aggiuntavi tin' indagine intorno ai fomuni Errori d'Osservazione nella Terayeutica di questa Ftbbre, Di 0. Razohi^ frotomedicojec. Miiauo, 1813. * credit. The opposition of the followers of the more ancient doctrines became gradually less active; and many of those antagonists, amongst whom were observant physicians who, finding that some of the most famous precepts of Brown were deleterious to mankind, and contrary to their own experience and that of their predecessors, whilst they followed in their practice the instructions derived from the latter sources, did not venture to censure them publicly, so great was the fanaticism with which the Brunonian theory was almost universally received. At this arduous period of enthusiasm appeared the celebrated work of Giovanni Rasoui on the epidemic of Genoa in the year 1800; and the unbounded reputation of the Scotch physician immediately became somewhat shaken, and his maxims regarded in Italy with less idolatrous veneration.
In 1799 there appeared in Genoa, affecting simultaneously many individuals, a fever, which, by the most evident signs, was discerned to be petechial. It made more progress towards the middle of the year 1800; and it seemed to be from Nice that its origin was derived. It propagated itself, as usual, principally, and with most severity, when the patients were most accumulated ; but, on some occasions, it could not be discerned by what secret way the disease had been communicated to persons the most cautious and retired, who had not escaped its attack. Those circumstances, however, present nothing that is singular, or not common to other epidemics. Neither were there any extraordinary facts of importance in the progress of the morbid phenomena, which are not unfrequently remarkably altered and modified in ^epidemic maladies.
This disease commenced with heavy pain in the head, or with a sense of vacuity ; sometimes to this there was added a slight degree of mental derangement, which afterwards became furious delirium. Preceded by alternations of shivering and heat, or by heat alone, or by neither, the fever at length manifested itself, simulating, in some cases, the access pf a mild catarrhal affection. Almost all the patients complained, from the first period of the disease, (which it is important to remark,) of remarkable muscular debility, which in some was so great, that they fainted, on making the slightest exertions. The other phenomena of the first stage were in no respects novel. There were often pains in the joints, universally or locally, and especially in those of the extremities. The countenance varied in its appearance; it was in some instances hotand tumid, with the eye lids a little closed; in others pallid, but pever of the intense white colour, and singular depression of physiognomy, that accompany fever really nervous. The eyes, in general, had an appearance of vivacity, and were more lucid than ordinary. The skin was very warm, but not of a burning heat. The thirst not very excessive. The tongue often, in the beginning, of the natural appearance ; in the course of the disease, under the continued operation of purgatives, covered with a white, and, in some cases, with an intense yellow, crust. Sometimes humming and singing in the ears on the first c}ays, were the precursors of deafness, which, appearing towards the latter stage of the disease, announced approaching dissolution. Obstinate watching and inquietude, increasing, and then changiu into 70 Foreign Medical Science and Literature. stupor, under the inconsiderate nse of opiates. The pufse, at tfce commencement, from 80 to 100 in a minute; small, obscure ; rarefy strong and full, and sometimes singularly weak and indiscernible. The urine was too various to permit any certain signs to be deduced from its appearances. Copious sweating, in many cases, daring the first few days, and especially in the night. The bowels were constipated, but particularly susceptible of the influence of purgatives, and subject to diarrhce*. Epistaxis was not unfrequent, and was always beneficial in proportion to its abundance.
Matters went on thus for three, four, or five, days. The disease tben became aggravated, and accompanied with convulsive movements. Fainting,sometimes without evident cause, or in the act of evacuating the bowels; and commonly subsultus of the tendons, and tremulous tongue. Deglutition was not always perfectly free. The pulse varied in diverse individuals, and its rate was different at different times of the day. Generally, or most frequently, it was intermittent, small, or so sunk as to be totally lost; but it ordinarily became strong when the disease was more advanced, and under an energetic depletory mode of treatment, Petechias, or an analogous eruption; miliary spots; one op both then appeared ; but they were not present in the mildest cases of disease, and they were copious in proportion to its severity. I n one case, an erysipelatous affection occurred simultaneously in the head and face. In another, the skin and albuginca were of an intense yellow colour. Sometimes there were exanthemata, which left the skin rough andscaly. In almost all cases there was delirium or stupor, or alternation of both. The former was so ferocious in some cases, as to require the patient's liberty of movement to be confined to prevent suicide, to which there was inclination. They then refused to swallow ; and the tongue became swelled, dry, and of a deep-red or black colour, as well as the teeth. Meteorism was not rare; occurring, for the most part, in those who lived after suffering abundant evacuations by stool, which were sometimes sanguineous and profitable. Ischuria was protracted, in one case, however, to the period of convalescence. Hiccough was very obstinate. Vomiting was rare, which also generally, when it happened, arose from large doses of tartrite of antimony, and was attended with pain and difficulty. Respiration was but very rarely affected. Restlessness arose almost solely from the treatment with stimulants. In one instance only, the disease commenced with all the symptoms of peripneumonia. Convalescence presented nothing worthy of particular notice. It was accompanied with, or ordinarily announced by, frequent spitting ; without, however, any affection of the chest being manifest; and, on the decrease of fever, or on the cessation of delirium and stupor, with great sadness, irascibility, or very remarkable fear of death.
We may sufficiently understand, from what has already been said, what species of disease the celebrated Professor had to contend with. How did he cure it? Having long modelled his medical doctrine on the principles of Brownism, he was naturally conducted by the predominant idea of asthenia. Every thing conspired to lead him to form that opiniou of its nature. He considered the circumstances which Hasori, on the Petechial Fcoev of Gema.
?t preceded tlie first breaking-out of the disease, and those which accompanied its attack and progress. Those were, the flow into Genoa, la the end of the summer of 1799> ?f many Cisaipines and other refugees, victims, generally, of the most severe depressing passions, exhausted by excessive fatigue, long exposed to heavy rains, and confined1 to very ill and insufficient nutriment.
What gave some weight to the indications from the symptoms, were the evident and remarkable prostration of strength from the onset of the malady, the irregularity and smallnes* of the pulse, and the disposition to fall into syncope. On contempiat.
ing the external characters of the disease, the apparent phenomena clearly announced, at least, a typhous or nervous fever, which Brownism referred to the most depressed state of asthenia. On reflecting that the typhus was petechial, he was induced to consult what the reformer of Scotland said on the subject; for though, considering itae the product of a contagion, it would have taken its place in the fourth division of local diseases, yet, from its being complicated with phenomena of universal affection so worthy of consideration, and caused by circumstances so debilitating as those above described, it should manifestly enter into the ordinary class of universal diseases and of the most profound asthenia; and as such he was obliged to regard it. Lastly, judging, as they are, the authors of former ages worthy of being consulted, he wished to know what in this case would be their advice: the doctrines of these, although in general contrary to the maxims of Brown, did not, however, refute him in the notions that, where sucti sadden iangour of the vital actions appeared so evident, the existence of pathological debility was undeniable, and required us to oppose it immediately with all the measures considered to be corroborant.
According to those principles and those reflections, Professor Rasoti judged that, whether the asthenia was direct or indirect, (although he had already formed many doubts respecting the propriety of the extensive application accorded to the latter,) it was right to stimulate; but be fortunately fulfilled this precept in a manner somewhat less determu nately than the remains of the doctrine of Brownism inculcated. JEveiy thing, excepting subtraction, stimulate, according to Brown: water and a diet of vegetables, which debilitate, debilitate because they stimulate too little. Emetics and purgatives, which debilitate, debiiu ' tate because the quantity of the stimulus of both together is less than the quantity of stimulus subtracted by the evacuations they promote. G. llasori was not well assured of the correctness of those notions;^and he could not make up his mind to think all the former physicians had been in error who believed that there were some substances which directly debilitate without producing subtraction,? such as sedatives, refrigerants, dilutescents, &c.; or, speaking more rigorously, which directly cause organic actions precisely opposite to those produced by stimulating powers. Many doubts, at least, on those points existing iu the mind of the author, a most happy consequence arose: it was, that, intending to stimulate, to free himself from the danger of contradiction in the means of cure, he determined not to excite with those indeterminate remedies whose qualities did not admit 79t Fowign Medical Science and Literature. of certain decision, bat solely with those oil whose stimulant qualities there was no ground for controversy.
Having once determined the principle on which he should stimulate his patients, and considered, on the one hand, that this should be conformed t8 in that prudent manner which is proportionate to the severity of (he disease, without exceeding, or falling short, of the proper degree; and, on the other hand, that, by emplojing only certain and unequivocal stimulants, he should, in case he had adopted an erroneous mode of treatment, immediately detect this by the evident pernicious results; and, if an appropriate one, he might hope that nothing should prevent its general success. Having thus firmly settled his mode of conduct, he used as a vehicle a decoction of China-root, to which were added Hoffmann's anodyne, the liquid laudanum of Sydenham, and wine; an appropriate diet was conjoined, and all watery beverages proscribed: but he soon had to repent of his conduct, and of the Brunonian notions which had till then influenced his mode of contemplating the disease. Whilst this decisive method was put in practice, at the end of from twenty-four to forty-eight hours, sometimes sooner and sometimes lattfr, matters had manifestly assumed worse appearances. They we e not the ill consequences of the disease, which, whatever may be the mode of treatment, will increase, and run through its stages. The malady was too promptly and too manifestly exasperated; without any gradations, any proportion to the preceding state, or to the period that had intervened. The frequency of the pulse was increased, and its hardness more perceptible; the face red; the eyes sparkling; and the respiration less easy. Besides, as the author acutely reflected, ?? diseases really asthenic have not properly that character of obstinacy, by which they will become augmented in spite of an appropriate method of cure continued for several da) s : this obstinacy alone might lead to a strong presumption of the sthenic nature of the disease. What, then, was the resolution to be taken in such circumstances; and what change was to be made in the rn^de of cure ?
Those who know with what difficulty a. change of opinion on any subject takes place in a man who has lorig formed but one respecting it, will agree with us, that it is difficult to understand how the circumstances above described could produce such a revolution of ideas contrary to doctrines so long entertained, and lead to an opposite mode of treating the disease. A Brunonian, in spite of those occurrences, would have scrupled to renounce in a moment the favourite principles of his master: he would not have believed his eyes; he would have taken refuge in a thousand extraneous circumstances, and supposed that he had not employed appropriate stimulants, or given his remedies in doses sufficiently strong for the intensity of the disease. He would have opposed to his own experience a heap of ancient and modern authorities; and, proceeding with his stimulants, would at last have assumed an air of wonder at the insuperable nature of the malady against which he had to contend. We do not speak of things impossible. In the petechial epidemic, which, from the commencement of the present century, has overrun all I taly^ numerous Brunoniaos must tlasori, on the Petechial Fever of Genoa* 73 have seen similar phenomena to those observed by Professor Rasori 5 but we do not find that any change has taken place in their practice, even although the work before us has circulated through the hands of physicians.
The author's merit will be still more evident, when it is considered that, although he in the first instance had recourse to the Brunoniaa method, yet, knowing the coolness required for correct observation^ and the difficulties attendant on it, and how many important things ordinarily escape our attention, he resolved to have recourse to the, experimentum crucis,?that is, to a directly opposite mode of treatment.
He acted with caution in the first instance, but afterwards with more courage; but it was not long before he was convinced of the propriety of this second attempt. As the disease, on its first appearance, presented a character of mildness, and experience had not cor*firmed the propriety of his conduct, he was timid : his measures then were equivocal or inactive, consisting wholly in a sort of expectation,. He abstained from abstraction of blood; and merely moderated the diet, relinquished all heating substances, and directed the free use of diluent drinks. The only at all active medical measures he employed were, acidulated drink in large quantity, tamarinds, nitre, and other neutral salts.
When the epidemic, in the height of its fury, showed itself generally with a much more serious aspect, and he had sufficiently perceived with what courage and certitude he might act, he no longer stood on the defensive,?no longer doubted. Although it may be considered that he carried debilitating measures to a small extent, according to the idea of some furious partizans of the depletory method^ yet it cannot be said that they were not used in a decisive manner. He bled from the arm once or twice at the commencement, and, in one rare case, even alter the tenth day of the disease; and then, if bleeding seemed to be indicated, he applied cups to the shoulders, or leeches to the temples or neck, sometimes so as to obtain, on each occasion, eight or nine ounces of blood. Then he resorted to the use of antimony, In its preparations, as kermes or as tartar-emetic. He prescribed of the latter lour, six, eight, and sometimes more, grains, daily, to be taken in a large quantity of some ordinary aqueous drink ; and he proceeded thus until the decisive epoch of amendment. Sometimes he used kermes combined with nitre, in the proportion of a scruple of the latter with halt a grain or a grain of the former, every two hours.
Sometimes he alternated the two remedies. In the mean time he did not neglect the use of purgative glysters, for the most part rendered so by tartar-emetic ; copious aqueous and vegetable beverage, chiefly, in those who could easily obtain it, of decoction of tamarinds; free cir-? f 7 * dilation of cool air: the least and most light covering on the bed 5 vegetable jellies for the rich, and aqueous fruits for the poor; and in alia very restricted quantity of l'ood. Opium, camphor, China-root, wine, alcohol, ether, ammonia., epispastics, and vesicatories, were never employed. What were the results? Of a very great number of patients that came under the author's care, not one died, although the disease was so far from being innocent, that, from April to October, 1800, there was a mortality of 7,813 individuals.
NO. 251. l 7 4 Foreign Medical Science and Literature? It would, however, be easy to show the severity of many of th<* cases treated by the author, by transcribing from his work some of the accurate histories with which it is accompanied ; but for these we must refer to the original: we shall here only adduce some of the reflections that arise from the consideration of the circumstances above detailed.
It appears, then, that a method rigorously, and even energetically, antiphlogistic, refrigerant, and depressatory of stimulus and excitement, used from the onset of the disease until its termination, and steadily maintained, even when the phenomena indicated, in a manner the least subject to dispute, the presence of the pretended malignant, nervous, and asthenic, period ; not only is not injurious, but affords such manifest assistance, as to conduct to health, not a small number of patients, but all of them. Here, then, is a fact absolutely new, at that epoch in the records of our art which, as it were by enchantment, made ail those physicians who reason, lower the veil from before their eyes, and overthrew the long-venerated idol of malignity, of the be* Jieved immediate progress in typhus to real, to pathological, debility, and of the pretended necessity of using cordials and restoratives in the cases alluded tq. v In all past times, commencing with the epoch in which the petechia first appeared, this disease has been cured, and in general is now cured, by the most judicious physicians, by depressing means ; and there ware many who had to felicitate themselves, before Professor Rasori, on the success of their treatment of that disorder.
Even in the existing temple of the fanaticism of Brownism, many Brunonians, moderating the incendiary nature of their method by mingling with their real stimulants other substances, which we shall hereafter prove to be of an apposite class, are less destructive in their practice, and may boast of some success ; but, unfortunately, the opinion has been invalidated amongst those physicians that made them see a species, a form, of the disease, a period in the same, or sometimes a particular epidemic character, where the apparent langour of the vital powers, the supposed colliquative phenomena, the diarrhoea, the meteorism, the excessive epistaxis, the tremulus of the muscles, lypothymia, the smallness and lowness of the pulse, the general depression of the cerebral functions, the subdelirium,?announced, more or less clearly, the necessity of a stimulant, heating, analeptic, and cardiac, mode of treatment, the occasion for invigorating by stimulating means, and the precept to abstain rigorously from all that could depress or debilitate. Nevertheless, Pieu da Castiio had said on the same occasion, u Detrahtndus staiim sanguis est per venam at dam, maxime quantum Jieri possit ab initio. Est enim hate operatio tanti momentt, ut ilia neglecta, vix faustum eventum in hac jtbre vobis liceat sptrare, quantum cumque blateret indoctum vulgus:" and he added, " Extrahite in principia aiacriter sanguinemand prescribed largely, at the same time, the use of mild purgatives, cupping with scarification, the application of leeches to various parts, emollient glysters, cold and acidulous drinks, affusion with water and oil mingled with nitre; not hesitating to subjoin, " Si vero nulla sunt plenitudinis signa, cavete in hac cane llasori, on the Petechial Fever of Genoa. 75 pejus el angue, a venae seclione, post punticulamm prasertim exiium; and was careful to cease or moderate the use of the measures indicated, as soon as there appeared colliquationes, syncopes, exsolutiones9 anxietates; and directed, what is more, on such occasions, food sometimes of roasted meat, with cordial drugs,?as amber, musk^ generous wine; and recommended many alexipharmacs, amongst which were, as there might appear occasion, theriaca, mithridate, diascordium, and some compound remedies, with opium, musk, and ambergris. Not only did Pier da Castro adopt this method, but, ascending to still earlier authors, we find the same cautions, the same indications, as far upwards as the time of Boksieki ; and so cnracinated in physicians were these documents and prejudices, that, even after the third edition of the present work, many physicians, not unworthy of notice, followed this old method, and treated the disease, from mere carelessness, as it was treated by the Spaniard Da Castro. But, in addition to what has been stated, (he acute observer and excellent practitioner, whose work we are considering, was soon led to perceive how little conformable to reason was the doctrine just de. scribed. This was indeed expressly declared by the great Sydenham, in a proposition adduced by the author, that this false idea of malignity had been more destructive to human nature than the invention of gunpowder ; since it led many physicians to the use of cordials, alexipharmics, and a heating regimen, when they should, instead of them, have employed the most cooling remedies. But, unfortunately, Sydenham, for whom all show express veneration, or affect to do so, was not heard; nor were the opinions of other eminent authors, who expressed sentiments equally judicious, attended to on this occasion. The welU established facts were not borne in mind, of diseases of this species having been treated solely, from the first period to the last, and during the appearance of the most manifest nervous phenomena, merely by the external and internal use of iced-water, by Monardes, Todaro, and Cirillus; or, at least, admitting these facts, they endeavoured to maintain that ice, in such circumstances, acted by corroborating the system. The opinions of which we speak were generally diffused amongst physiciaus, according to which they admitted this dream of debility, when the work on the fever of Genoa, with novel observations so rigorously instituted, appeared to effect the overthrow of that And what can be opposed to this? Perhaps the veracity of the statements may be questioned ? But the facts occurred in one of the first-rate cities in Italy, under the eyes of many physicians whose names are mentioned in the work, some of whom are yet living, as well as a greater proportion of the patients whose histories the author has related in it. They occurrcd under the observation of physicians, many of whom were followers of the contrary method, and were interested in defending their own conduct by accusing that of the author.
After three editions of this work, no one has ventured to place in controversy the truth of those statements, although a legion of physicians have unchained themselves on other pretences against the founder ef the contrarstipaulant doctrine* And, indeed, should tbe sontroversy L 2 76 Foreign Medical Science and Literdture. be again agitated, the last petechial epidemic which unhappily spread throughout Italy, has given but little occasion to physicians to contest the truth of what has been related.
It may perhaps be said, that the nature of that particular epidemic, as well as the more recent one, and the particular circumstances of the patients, did not present the predominance of malignity and debility; and that there were not witnessed, very fortunatel), that complication "with hypo-asthenia which, in other epidemics and other patients, a great number of ancient and modern practitioners may have observed.
But, if this malignity, if this complication, has apparent and sensible characters; if these characters are not entirely metaphysical j and if they are said, by all ancient and recent observers, to be apparent by prostration of the pulse and strength, apparent vital languor, and the other signs that classic writers have extensively enumerated, not one of them was wanting in the greater proportion of those cases; and they will all be found there, even in the highest degree, joined, more* over, with preceding causes that are considered to be the most powerfully depressing; as the reader will perceive who has attended to the circumstances which have been premised.
Perhaps, too, it may be pretended, that, to the constancy of the fortunate success obtained by Professor G. Rasori, may be counter* poised the equal felicity of success, at other times, and by other physicians, certainly not favourers of these new sentiments, by using a method modified according to circumstances, by stimulating in the nervous period according to the ancient rules? Perhaps, <00, some may thence consider that this compromises the fact, or favours the ancient, not less than the modern, opinion ; or shows, at least, that the fundamental maxims, on which it rests as on a firm basis, are highly equivocal and fallacious ? But those who use these arguments have not taken into consideration a great number of circumstances which concur to refute them.
In the first place, we will concede to a certain degree, that some of the supporters of the doctrine of malignity were really so fortunate in many of their cures modelled on those pathological principles; but did not the generality of their medical measures owe their favourable success to the equivocal circumstances of their having been administered as stimulants and corroborants ?
Let us examine impartially their clinical conduct. How did they act when the pretended nervous stage commenced ? They relinquished, it is true, the use of venesection and antimonials. They renounced, after the seventh day, the exhibition of tartarized and nitrated drink. They gave wine and ether, which certainly stimulate; musk and opium, which stimulate: but, at the same time, they did not forego leeches io the nostrils or to the hemorrhoidal vessels, cups with scarification applied to the head, to withdraw the peccant humour, or remove irritation, or rouse the patient from stupor. Neither did they deny the use of ice, to corrugate the too-* Relaxed fibres of the stomach ; they covered the abdomen with ice, to corrugate it, and to relieve meteorism ; and they gave mineral lemon* to suppress diarrhoea, or the vegetable acids, to resist putridity, 77 Tbey at the same time ordered tepid, if not cold, baths, to eliminate from the skiri the contagious miasmata. They also employed purgative enemas; produced blisters, and kept them open ; recommended copious drinking of warm water as a diluent; prescribed kermes when the chest was affected, calomel, to neutralize the contagion, and atropa belladonna, to remove delirium. At the same time, whenever the pulse rose or became tense, on every attack of ferocious delirium, considering these as signs of irritation, or of phlogosis superadded to the nervous disorder, they recurred to venesection, or at least to bleeding with leeches and scarification ; on every indication of new oppression, they purged, or gave an emetic ; and we see, throughout the whole ot" their conduct in the treatment, the curious and contradictory alternative of distrusting to-day what they had done on the preceding one, and so throughout. They also conformed to the practical precepts of the classics, that the restoratives, corroborants, and excitants, should be given in proportion to the manner in which the patient would bear them, and at first very sparingly; and this parsimony was especiallyapplied to opium, wine, ether, ammonia, and to the things termed heating; and that the remedies which may be exhibited freely are, contrayerva, arnica, serpentary, and similar substances : in short, those whose qualities, if not sedative, as we pretend, are at least subject to controversy. In most cases, too, the debilitating treatment was used w hilst the disease maintained its severity, and the other was not resorted to until it was already conquered.
From these considerations, every one will perceive that the favourable results of a great number of cases treated in the preceding manner, opposed to those of a much greater number of cures effected by the use of debilitating measures from the commencement to the termination of the disease, prt)ve nothing against the latter* That the arguments might have any degree of force, it would be necessary to show that such favourable results, in a considerable number of cases, had arisen from the treatment conducted by wine, ether, opium, and salt of hartshorn, from the beginning to the end of the malady ; as, on the other hand, a multitude of cases were treated throughout with tartaremetic, nitre, cremor tartar, bleeding, and leeches, alone. There being by no means any parity of circumstances, the whole advantage is on our side,?the whole disadvantage presses on the favourers of the mixed method. Whilst, then, they wait for further experience to remove this disadvantage, let us in the mean time consider as of but little importance the difficulty here opposed to us, in the fortunate success of the mixed method on some occasions, whilst, on others, it has been followed by different results.
But, we think, in the second place, and all thufse will agree with us who are acquainted with the recent history of medicine,?we think, that there is no occasion for waiting for the consequences of the expe, rience just alluded to. We may anticipate their results. Setting out from the impossibility that a contradictory method might be beueficial where the opposite method is beneficial, we have an argument a minori ad majus, to use the language of the schools, that we may thus reveal the success that should be expcctcd from such a trial. Since the 79 Foreign Medical Science and Literature. mixed method succeedcd so unfavourably in the former epidemic? at Genoa, and in the more recent one, and modern and ancient practitioners ha*e in all times had to repent having lavished stimulants eve? where thev alternated remedies which subtracted from the influence o? the measures which increased the excitement, we may previously kno\r ?what will at best be the result of the treatment, purely and powerfully, ?f the stimulating kind.
The existence of malignity y then, in petechial fever, is a mere chimera; and this important fact, seen long since, in a glimmering light? by Sydenham, and then by Stoll, and by many others, has only lately been fully discerned by one of the founders of the reform in pathology: but, it theexi>tence of that malignity be chimerical in such a species of disease, as the work of Rasort teaches us; and if the presence of low and small pulse, prostration of physical power, sensible depression of vitality, tremors, convulsions, and stupor, may co-exist with a state of excitement ; what, then, becomes of this malignity in all analogous maladies?' What, also, becomes of this pretended debility of Brown in such circumstances? What reason had he for believing in the existence of malignity in cases perfectly similar to the present, in confluent variola, or in the other exanthemata, in low nervous fever, as it is so improperly termed, in typhus or other febrile diseases, which, in early times, were so efficaciously treated by the antiphlogistic method, anil the propriety of which the most modern have placed beyond dispute.
We have here only proposed what the preceding phenomena absolutely and rigorously substantiate; and we have elsewhere had frequent occasion to-observe how facts, examined with severe criticisn^ lead us to think, that in no sudden disease have the phenomena anything in common with real pathological debility,?we mean to say, idiopathic debility* We fortunately readily finfl, in other cases, cha* racters sufficiently differing from those above mentioned, to enable us to avoid confounding them, in the signs of real debility or contra* stimulation. Let us, then, guard against exclaiming, with some, Debility does not exist, according to the modern doctrine: the old, and? as they were considered, true signs of it, fail to demonstrate it! Let us, however, endeavour not to confound mere appearances with reality, and finally to establish this first law, which results in the first instance from the work we have examined : 7 he false debility of the patients in the disease above described, is an illusion, a mere appearance ; ami the disease is successfully. combat ted solely by a method vigorously and purely antiphlogistic.
Dr. Kohler's Case of Thoracic Disease* 79 malady. About six months since, she began to show evidences oC disease: her appetite became impaired, she was disposed to solitude^ and would often leave her childish amusements to go and weep alone* without any evident cause. The parents attributed this conduct chiefly to a peevish disposition, and thought moral and domestic ma. nagement most proper for its correction. This state of disorder, however, soon assumed a more serious character: the child daily became enfeebled and emaciated, and a swelling appeared outwardly on the left side of the chest. The parents then brought her to the lioyal Clinical Institution, where she came under my care on the 5th of November, 1817-The following were the circumstauces developed on a careful examination of the history and present state of the disease.
Oii the left side, near to the sternum, about the region of th*j fpurth, fifth, and sixth, ribs, there was a preternatural protuberauce of the thoracic parietes: the skin over this was of a bluish colour, from congestion of blood in the veins. Powerful pressure on this part caused darting painful sensations. A throbbing of the heart was clearly evident externally ; and, on the application of the hand to the swelling, the violent action of that organ became more forcibly distinguished. The pulse was quick, full, and regular; but there was a difference in respect to its strength in the two arms: it was fuller and harder in the left than in the right one. The cheeks of the patient were of a marked red colour; but, according to the father's statement, when she fell into fits of passion, and which she was much inclined to, they, as well as the lips, became of an extraordinary pallid hue. There was a remarkably bluish tinge throughout the sclerotica of both eyes. The child complained of oppression of respiration, darting pains in the chest, especially in the region of the swelling, with which the cough she had, and the throbbing of the heart, were increased ; she had also pains in the head, flushing of heat about her, and a disinclination for food. Her sleep was unquiet, and commonly disturbed by dreams, in which she often cried out aloud for help, waking her parents ; but she could give no reason for this, and did not complain then of any severe pain. The evacuations from the bowels were natural in appearance, as well as the urinary secretion. With the foregoing circumstances there were signs of worms present,?that is, dilatation of the pupils, itching in the nostrils, occasionally attacks of pain in the belly, drawing-up of the feet during sleep, and occasional fits of voracious appetite for bread, and the like substances. The functions of the rest ot the abdominal viscera appeared to be in the natural state. The general appearance of the habit presented signs of a scrofulous disposition. But the immediate cause of the present disease was not at all evident. The father recollected her having had a fall on the chest a few years since, but the child had received from it no apparent injury.
There were, however, existing evidences of an inflammatory dispo-.this history will only be here given ; as one of the most important circumstances in the subject of it, the pervious state of the foramen ovale, will he considered in a general manner in the Historical Essay for the period just elapsed.?Edit.

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Foreign Medical Science and Literature.
sition that should be combatted: the pain, the cough, and the inordU uate force of the actions of the vascular system, showed it in a decisive manner.
But here was an important question to be determined,?
"whether the functions of the heart were disordered from actual organic lesion, of an inflammatory nature, of its own structure; or whether some other of the thoracic organs was the seat of the disease, and thai which produced the external swelling ? The prognosis was necessarily unfavourable. The mode of cure ?was founded on the following indications; l?, to combat the inflammatory state of4he vascular system by sedatives, and by lessening the quantity of blood ; 2*, to support tfie strength of the patient by restoratives not possessing heating qualities.
Four leeches were ordered tp be applied to the chest, and the bleeding afterwards promoted for several hours; aud a mixture of infusion of digitalis, with nitre, to be taken inwardly.
Nov. 15th,?The child is altogether better: she sleeps more quietly, and her appetite for food begins to improve. She is also somewhat livelier, and more inclined to partake of the ordinary amusements of children.
The state of the pulse, the throbbing of the heart, and the dyspnoea, are still the same. The signs of the presence of worms in the intestines are much as before; the patient has complained of pain in the belly. I therefore prescribed, in addition to the former medicines, that a tea-spoonful of the anthelmintic electuary of the Prussian Pharmacopoeia shouM be given every morning and evening. The swelling to be fomented with cold water.
Nov. c20th>?Several ascarides have been passed from the bowels.. The inflammatory symptoms are not lessened. The pains in the chest, and the cough, are somewhat alleviated: but the child is more lowspirited ; she has wept almost all the day, and her sleep has been very unquiet, and much disturbed by dreams. The state of the pulse and respiration is in the same state as before. Four leeches to be applied to the chest; the anthelmintic electuary and cold fomentation to be continued, and the quantity of digitalis in the mixture to be increased.
Dec. 2.?The mixture has produced sickness, vomiting, and headach. No more worms have been passed. The throbbing of the heart Is not quite so violent: in other respects, the state of the patient is similar to that of the 20th of November.
The dose of the digitalis to be diminished; and a mixture made with infusion of valerian, laurelwater, and extract of hyosciamus, to be taken occasionally. The use of the electuary, and the fomentation, to be persisted in; but the water to be rendered colder by admixture with ice or snow.
Dcc. 20.?Some more ascarides have been passed. The pulse is not quite so full, and less frequent; the appetite is not quite so good as it was a few days since; the sleep has been much disturbed by dreams; the signs of worms are still very evident; the pains in the chest occur less frequently, and are also less severe. The infusion of digitalis with nitre to be continued; a decoction of staves-acre, with extract of wormwood and tartrate of potash, to be also administered; the mixture of valerian, &c. and the application of cold water externally, to be continued.